. 2021 Jul 22;bjsports-2021-104203.
doi: 10.1136/bjsports-2021-104203.
Online ahead of print.
Seung Won Lee
1
, Jinhee Lee
2
, Sung Yong Moon
3
, Hyun Young Jin
3
, Jee Myung Yang
4
, Shuji Ogino
5
6
, Mingyang Song
5
, Sung Hwi Hong
7
, Ramy Abou Ghayda
8
, Andreas Kronbichler
9
, Ai Koyanagi
10
11
, Louis Jacob
10
12
13
, Elena Dragioti
14
, Lee Smith
15
, Edward Giovannucci
5
16
17
, I-Min Lee
5
18
, Dong Hoon Lee
17
, Keum Hwa Lee
19
, Youn Ho Shin
20
, So Young Kim
21
, Min Seo Kim
22
, Hong-Hee Won
22
, Ulf Ekelund
23
24
, Jae Il Shin
25
, Dong Keon Yon
26
Affiliations
Affiliations
- 1 Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
- 2 Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of).
- 3 Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of).
- 4 Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of).
- 5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- 6 Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
- 7 Yonsei University College of Medicine, Seoul, Korea (the Republic of).
- 8 Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
- 9 Deparment of Medicine, University of Cambridge, Cambridge, UK.
- 10 Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain.
- 11 Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain.
- 12 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
- 13 Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
- 14 Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
- 15 The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, UK.
- 16 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
- 17 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- 18 Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- 19 Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
- 20 Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea (the Republic of).
- 21 Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of).
- 22 Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of).
- 23 Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
- 24 Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
- 25 Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
- 26 Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
Free PMC article
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Seung Won Lee et al.
Br J Sports Med .
2021 .
Free PMC article
. 2021 Jul 22;bjsports-2021-104203.
doi: 10.1136/bjsports-2021-104203.
Online ahead of print.
Authors
Seung Won Lee
1
, Jinhee Lee
2
, Sung Yong Moon
3
, Hyun Young Jin
3
, Jee Myung Yang
4
, Shuji Ogino
5
6
, Mingyang Song
5
, Sung Hwi Hong
7
, Ramy Abou Ghayda
8
, Andreas Kronbichler
9
, Ai Koyanagi
10
11
, Louis Jacob
10
12
13
, Elena Dragioti
14
, Lee Smith
15
, Edward Giovannucci
5
16
17
, I-Min Lee
5
18
, Dong Hoon Lee
17
, Keum Hwa Lee
19
, Youn Ho Shin
20
, So Young Kim
21
, Min Seo Kim
22
, Hong-Hee Won
22
, Ulf Ekelund
23
24
, Jae Il Shin
25
, Dong Keon Yon
26
Affiliations
- 1 Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
- 2 Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of).
- 3 Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of).
- 4 Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of).
- 5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- 6 Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
- 7 Yonsei University College of Medicine, Seoul, Korea (the Republic of).
- 8 Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
- 9 Deparment of Medicine, University of Cambridge, Cambridge, UK.
- 10 Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain.
- 11 Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain.
- 12 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
- 13 Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
- 14 Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
- 15 The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, UK.
- 16 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
- 17 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- 18 Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- 19 Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
- 20 Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea (the Republic of).
- 21 Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of).
- 22 Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of).
- 23 Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
- 24 Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
- 25 Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
- 26 Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of) yonkkang@gmail.com lsw2920@gmail.com shinji@yuhs.ac.
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Abstract
Purpose:
To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.
Methods:
Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.
Results:
Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500-1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.
Conclusion:
Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.
Keywords:
COVID-19; physical activity.
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: None declared.
Figures
Figure 1
Participant profile in all cohort.
Figure 1
Participant profile in all cohort.
Figure 1
Participant profile in all cohort.
Figure 2
Directed acyclic graph demonstrating the…
Figure 2
Directed acyclic graph demonstrating the implicitly assumed causal association between physical activity (‘exposure’)…
Figure 2
Directed acyclic graph demonstrating the implicitly assumed causal association between physical activity (‘exposure’) and risk of COVID-19 (‘outcome’) in the Korean nationwide cohort before matching. Confounders, potential mediators and exposure–outcome associations are indicated. BMI, body mass index; BP, blood pressure; CCI, Charlson comorbidity index; CVD, cardiovascular disease; GFR, glomerular filtration rate; TB, tuberculosis.
Figure 3
Association between physical activity according…
Figure 3
Association between physical activity according to 2018 physical activity guidelines for Americans and…
Figure 3
Association between physical activity according to 2018 physical activity guidelines for Americans and SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death in cohort A. (A) Association between physical activity according to MET score and SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death in cohort C (B) and cohort D (C). The level of physical activity was categorised into four: (1) inactive (0 MET min/week), (2) insufficiently active (0–
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